Must medical experts repeat 'reasonable degree of medical probability' for each opinion? Sprague v. Avalon Care Center Explained

In medical malpractice cases, expert testimony forms the backbone of establishing both standard of care and proximate cause. But must medical experts rigidly repeat the phrase “reasonable degree of medical probability” for each opinion they offer? The Utah Court of Appeals addressed this question in Sprague v. Avalon Care Center, providing important guidance for practitioners handling medical malpractice appeals.

Background and Facts

Morley Sprague, an elderly man with advanced multiple sclerosis, was admitted to Avalon Care Center where he developed severe pressure ulcers during his 29-day stay. What began as a stage one pressure ulcer deteriorated to the point where bone was exposed and became infected. Despite subsequent treatment attempts, Sprague died 22 months later. His family sued for medical malpractice and wrongful death, ultimately obtaining a $2 million jury verdict after a six-day trial featuring testimony from seventeen witnesses, including multiple experts.

Key Legal Issues

Avalon challenged the trial court’s denial of its motion for partial directed verdict, arguing that expert Kevin Emmons failed to establish the standard of care because he did not expressly state each opinion “to a reasonable degree of medical probability.” The court also addressed various challenges to expert witness testimony from multiple witnesses, including scope of cross-examination and foundational requirements.

Court’s Analysis and Holding

The Court of Appeals affirmed, holding that expert testimony should be “viewed as a whole and analyzed on its substance.” While experts must express opinions with sufficient certainty, Utah law does not require the ritualistic repetition of “reasonable degree of medical probability” for each opinion when the expert has already established that foundational standard. The court emphasized that expert testimony requires only “a basic foundational showing of indicia of reliability,” not rigid adherence to specific phraseology.

Practice Implications

This decision provides important guidance for medical malpractice practitioners. When presenting expert testimony, establish the reasonable degree of medical probability standard clearly at the outset, then ensure subsequent opinions logically flow from that foundation. The court’s holistic approach means experts need not repeat magical incantations, but their testimony must demonstrate sufficient certainty throughout. For appellate practitioners, this decision reinforces the highly deferential standard of review for directed verdict challenges based on evidence sufficiency and the broad discretion trial courts possess in managing expert testimony.